SCHOLARSHIP APPLICATION

 

APPLICANT'S PHOTO(Required)
Accepted file types: jpg, jpeg, png, gif.

 

DD slash MM slash YYYY

PRESENT ADDRESS

PERMANENT ADDRESS

PARENT'S DETAILS

If you are staying in Ediga hostel or Government Hostel Please mention the address

DETAILS OF COLLEGE STUDYING FOR THE YEAR 2024 -2025

DETAILS OF MARKS SECURED IN PREVIOUS 3 YEARS

Academic year 2023-2024

Academic year 2022-2023

Academic Year 2021-2022

PARTICULARS OF PREVIOUS SCHOLARSHIP AVAILED (IF ANY)

BANK DETAILS OF APPLICANT

Declaration(Required)

I, hereby, declare that I have submitted a self-attested photocopy of the required documents as mentioned below:
☐ Caste Certificate ☐ BPL Card ☐ AADHAR Card ☐ Current Year College Fee Receipt ☐ Marks Card of 2023-2024 ☐ Marks Card of 2022-2023 ☐ Marks Card of 2021- 2022 ☐ Bank Pass Book (First Page)

 






Signature of Applicant



Date

 










Signature and Seal of Head of Institution



Date



 





   Signature of Applicant's Guardian



  Date



ATTESTATION OF TALUKA MUKHYA SANCHALAKA


NAME:


SEAL & SIGNATURE


CELL NO:


ATTESTATION OF DISTRICT MUKHYA SANCHALAKA


NAME:


SEAL & SIGNATURE


CELL NO:
 

_______ For Office Use ________________________________________________________________


Scrutinized by:

Remarks:



Signature:

Date:
☐ SANCTIONED

☐ REJECTED